1. Normal Speech and Language Development
Heidi M. Feldman MD PhD
Ballinger-Swindells Professor
Stanford University School of Medicine

2. Faculty Disclosure Information
In the past 12 months, I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

3. Role of Pediatrician
Screening for delays and disorders in language requires pediatrician to know developmental course and red flags for abnormal/slow progress
Evaluation of children with documented delays and disorders requires pediatrician to generate differential diagnosis
Support for children and families receiving treatment for developmental delays and disorders requires general concepts re: SL therapy

4. Learning Objectives Define language, speech, and components
Recognize normal development birth to 7 years
Discuss the fundamental requirements for language

5. Communication
The activity of conveying, transmitting, exchanging information
Uses a common system though not necessarily intentionally
Examples
A bird’s mating song
An infant’s cry
A person’s shudder in the cold
A child placing a parent’s hand on the door when she wants to leave

6. Language Complex and distinctly human skill Two defining features
Symbolic
Rule-governed system
Allows people to understand and produce an infinite number of messages
Allows communication about non-present, future, abstract, hypothetical
Cements social interactions

7. Speech Usual output of the language system
Requires coordination of respiratory and oral motor mechanisms
Other outputs of the language system
Sign language
Written language

8. Component of Language Expressive versus Receptive skills
Phonology: Speech sounds in a language with reference to distribution, patterning, and tacit rules of pronunciation
Morpho-syntax: Regularity in grammatical features, such as word order, and internal structures of words, such as prefixes and suffixes that affect meaning
Semantics: meaning (literal and figurative) at the levels of words, phrases, sentences, and discourse
Pragmatics: social functions of language
Using language for different purposes
Changing language according to the needs of a listener or situation
Following rules for conversations and storytelling

9. Requirements for Speech
Plan and organize respiratory and oral motor mechanism
Control breath and muscles
Produce speech sounds in isolation and context
Regulate voice and resonance
Speak fluently

10. (Expressive & Receptive)
Coordinating
breath &
movements
Motor
planning,
execution
Speech
sounds
Voice &
resonance
Speech Sounds
Fluency
SPEECH
&
LANGUAGE SKILLS
(Expressive & Receptive)
Obeying
rules
Phonology
Pragmatics
Morpho-Syntax
Semantics

11. Language Learning Observational and social learning
No direct instruction
Biological factors
Human brain is self-organizing system
Infants pick up statistical properties in speech
Infants link speech perception to motor output
Environmental factors
Children learn language of their environment

12. Overview: Language Learning
Infancy: development of pre-linguistic
At 1 year: First words beyond ma-ma and da-da
18-24 months: Slow progress, receptive skills first
24 months: Explosion of vocabulary, grammar
24-48 months: Dramatic growth in vocabulary, grammar
4 - 5 years: mature language skills
7 years: mature speech sounds
Over 7 years: Application of language and speech to concepts, reading, and academic skills

13. Building Blocks at Birth
Enter into a quiet alert state
Turn to the source of sound
Prefer the human voice to other sounds
Look at faces
Track and follow
Prefer faces to other stimuli

14. Developments in Infancy
Age
Receptive
Expressive
2 – 4 months
Statistical patterns
Coo
6 months
Turns to name
Babbles
9 months
Verbal routines wave bye-bye
Mama, Dada
12 months
Early Words
First words

16. Pre-linguistic Behavior

17. Early Language
Video

18. Observations

19. Additional Toddler Skills
Age
Receptive skills
Expressive skills
12-15 months
Follows 1-step commands with gesture
Slow increase in words
15-18 months
Simple pronunciation
Over or under-generalization

20. Early Grammar

21. Observations

22. More on Early Grammar

23. Preschoolers Age Receptive skills Expressive skills 30 months
Follows 2-step commands
Asks what’s that
36 months
Asks why
48 months
Creates narratives

24. Preschool Language

25. Observations

26. Narrative Discourse

27. Observations

28. Early School Age Receptive language Expressive
Limited by conceptual and social understanding
Limited by attentional capacities
Gaps in understanding are subtle
Expressive
Increasing use of complex structures
Immaturities in speech (r, l, w, y, consonant blends)

29. Later School Age Reading as language-based skill
Requires mapping letters (graphemes) to sounds (phonemes)
Requires rapid naming
Relies on verbal memory
Reading highly associated with phonemic awareness (rhyming, word games)

30. Requirements for Language Learning
Functioning
Healthy & Normal
Intact
Adequate
Supportive
Oral mechanisms
Human brain & cognition
Hearing
Verbal Input
Social interactions

31. Differential Diagnosis of Language Delays or Disorders
Low SES, parents with limited education
Inadequate,
adult-centered
Verbal input
Abnormal structure or function
Genetic or Neurologic
Disorders
Impaired
Un-supportive
Cleft palate, velo-pharyngeal insufficiency
Cognitive Disability, Neuro, Autism, SLI
Sensori-neural hearing loss
Child abuse or neglect, orphanage
Oral mechanisms
Human brain
Hearing
Social interactions

32. Summary
Language is a uniquely human ability, characterized by symbolic communication
A few key milestones allow detection of normal development and developmental delays
Language development occurs in the context of social interactions and rich verbal input

33. Thank you.